Observational studyIntensive care medicine2014
De-escalation of antimicrobial treatment in neutropenic patients with severe sepsis: results from an observational study.
Observational study in Intensive care medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 66 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
66 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Antimicrobial De-Escalation in the ICU: From Recommendations to Level of Evidence.Advances in therapy · 2020Pooled it
- Strategies to reduce curative antibiotic therapy in intensive care units (adult and paediatric).Intensive care medicine · 2015Guideline
- Targeted simplification versus antipseudomonal broad-spectrum beta-lactams in patients with bloodstream infections due toBMJ open · 2017Trial
- Efficacy and safety of de-escalation therapy to ertapenem for treatment of infections caused by extended-spectrum-β-lactamase-producing Enterobacteriaceae: an open-label randomized controlled trial.BMC infectious diseases · 2017Trial
- De-escalation versus continuation of empirical antimicrobial treatment in severe sepsis: a multicenter non-blinded randomized noninferiority trial.Intensive care medicine · 2014Trial
- Optimal antibiotic use in the intensive care unit.Critical care (London, England) · 2025Review
- Antibiotic De-Escalation in the Intensive Care Unit: Rationale and Potential Strategies.Antibiotics (Basel, Switzerland) · 2025Review
- The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024.Journal of intensive care · 2025Article
- Septic shock in the immunocompromised cancer patient: a narrative review.Critical care (London, England) · 2024Review
- Antimicrobial De-Escalation in Critically Ill Patients.Antibiotics (Basel, Switzerland) · 2024Review
- ICU-acquired infections in immunocompromised patients.Intensive care medicine · 2024Review
- Bloodstream infections in pediatric hematology/oncology patients: a single-center study in Wuhan.Frontiers in cellular and infection microbiology · 2024Article
- Antibiotic stewardship in the ICU: time to shift into overdrive.Annals of intensive care · 2023Review
- Impact of Positive Culture Reports ofInfection and drug resistance · 2023Article
- Antimicrobial Stewardship during COVID-19 Outbreak: A Retrospective Analysis of Antibiotic Prescriptions in the ICU across COVID-19 Waves.Antibiotics (Basel, Switzerland) · 2022Article
- The Relationship Between Antibiotic Agent and Mortality in Patients With Febrile Neutropenia due to Staphylococcal Bloodstream Infection: A Multicenter Cohort Study.Open forum infectious diseases · 2022Article
- Characteristics and Outcomes of Bloodstream Infections in a Tertiary-Care Pediatric Hematology-Oncology Unit: A 10-Year Study.Journal of clinical medicine · 2022Article
- Infection prevention requirements for the medical care of immunosuppressed patients: recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute.GMS hygiene and infection control · 2022Article
- Successful management of colistin- and carbapenem-resistantSAGE open medical case reports · 2022Article
- The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020).Journal of intensive care · 2021Article
6 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn severe sepsis, guidelines recommend de-escalating the empirical antimicrobial treatment as soon as the microbiological results are available. We aimed to determine the rate of de-escalation of the empirical antimicrobial treatment in neutropenic patients with severe sepsis. The characteristics of antimicrobial treatment associated with de-escalation and its impact on short- and long-term survival were also determined.
methodsIn the intensive care unit (ICU) of a cancer referral center, we prospectively collected observational data related to the antimicrobial management in neutropenic patients who developed severe sepsis and were admitted to ICU for at least 48 h. De-escalation of antimicrobial therapy consisted either of deleting one of the empirical antibiotics of a combined treatment, or, whenever possible, to use a betalactam antibiotic with a narrower spectrum of activity. Multivariate logistic regression was conducted to determine the factors associated with de-escalation, while a Cox proportional hazards model with a time-dependent covariate was fitted to assess the effect of de-escalation on 30-day survival. Finally 1-year survival after ICU discharge was compared across de-escalation groups.
resultsCumulative incidence of de-escalation of the empirical antimicrobial treatment among the 101 patients of the cohort was 44%, [95% confidence interval (CI) 38-53%], including 30 (68%) patients with ongoing neutropenia. A microbiological documentation was available in 63 (63%) patients. Factors associated with de-escalation were the adequation of the empirical antimicrobial treatment in ICU [OR = 10.8 (95% CI 1.20-96)] for adequate documented treatment versus appropriate empirical treatment, the compliance with guidelines regarding the empirical choice of the anti-pseudomonal betalactam [OR = 10.8 (95% CI 1.3-89.5)]. De-escalation did not significantly modify the hazard of death within the first 30 days [HR = 0.51 (95% CI 0.20-1.33)], nor within 1 year after ICU discharge [HR = 1.06 (95% CI 0.54-2.08)].
conclusionOur data suggest that, in ICU, de-escalation of the empirical antimicrobial treatment is frequently applied in neutropenic cancer patients with severe sepsis. No evidence of any prognostic impact of this de-escalation was found.
Indexed as
Identifiers
24231857What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.